Importance: Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease that has caused a global pandemic. The presenting symptoms are mainly respiratory symptom, yet studies have reported nervous system involvement in the disease. A systematic review and meta-analysis of these studies are required to understanding the neurologic characteristic of the disease and help physicians with early diagnosis and management. Objective: To conduct a systematic review and meta-analysis on the neurologic characteristics in patients with COVID-19. Evidence Review: Authors conducted a literature search through PubMed from January 1st, 2020 to April 8th, 2020. Furthermore, the authors added additional sources by reviewing related references. Studies presenting the neurologic features of COVID-19 patients in their data were included. Case reports and case series were also included in this review. The quality of the studies was assessed based on the Oxford Center for Evidence-Based Medicine guidelines. Selected studies were included in the meta-analysis of proportion and the heterogeneity test. Finding: From 280 identified studies, 33 were eligible, with 7,559 participants included. Most of the included studies were from China (29 [88%]). Muscle injury or myalgia was the most common (19.2%, 95%CI 15.4-23.2%) neurologic symptom of COVID-19, followed by headache (10.9%, 95%CI 8.62-13.51%); dizziness (8.7%, 95%CI 5.02-13.43%); nausea with or without vomiting (4.6%, 95%CI 3.17-6.27%); concurrent cerebrovascular disease (4.4%, 95%CI 1.92-7.91%); and impaired consciousness (3.8%, 95%CI 0.16-12.04%). Underlying cerebrovascular disease was found in 8.5% (95%CI 4.5-13.5%) of the studies. Conclusion: Neurologic findings vary from non-specific to specific symptoms in COVID-19 patients. Some severe symptoms or diseases can present in the later stage of the disease. Physicians should be aware of the presence of neurologic signs and symptoms as a chief complaint of COVID-19, in order to improve management and prevent a worsening outcome of the patients.

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Introduction Preliminary study showed that coronavirus disease 2019 (COVID-19) disrupt body immune system including dysregulation of cytokine interleukin-6 (IL-6). IL-6 inhibitors agents have been used as treatment option for COVID-19, yet their benefit as therapeutic agent remain unclear. Objective We performed a systematic review and meta-analysis to synthesize the available evidence on the potential therapeutic effect of IL-6 inhibitor agents for the treatment of COVID-19. Methods Two authors initially screened and reviewed the relevant studies from available databases. The data extracted will be tabulated and analyzed for the outcomes. The primary outcome was mortality. Secondary outcomes included discharge from hospital, length of stay, and requirement for mechanical ventilation. The quality of each study was assessed using OCEBM ratings. Results We reviewed 18 studies with a total of 3303 subjects. Tocilizumab was the most commonly used in the studies (15 studies). Meta-analysis of included studies revealed significant reduction in mortality with tocilizumab and sarilumab (RR = 0.61, 95% CI 0.49–0,76). Other outcomes including hospital discharge (RR = 1.04, 95% CI 0.86–1.24), length of stay (mean difference –1.96 days, 95% CI –4.24 to 0.33) or requirement for mechanical ventilation (RR = 0.68, 95% CI 0.32–1.45) revealed no differences of IL-6 inhibitor agents compared to controls. Conclusions Available evidences suggests that IL-6 inhibitor agents do reduce the risk of mortality in COVID-19 especially in severe disease. Further well-designed trials are needed for assessing its efficacy and safety for COVID-19

The importance of pain education is widely accepted and recognized. This is a key part of educating the undergraduate and postgraduate healthcare workforce is an essential strategy for promoting effective pain practice. This study aims to evaluate the pain management module training courses for newly graduated doctors to address the knowledge gap between specialist care and primary care physicians. This was an observational study of an evaluation of a pain education project focused on neuropathic pain management core competency was provided. Multimodal teaching approaches such as didactic teaching and vignettes of cases discussion, video teaching, and learning module. A pretest survey was carried out to assess the baseline knowledge of the participants. Completion of the post-test and participant experience questionnaire were collected. Comparison of the preand post-test scores for all participants was undertaken using the Wilcoxon signed-ranked test with effect size calculated. The participant's experience questionnaire scores were analyzed descriptively to produce mean and standard deviations from each question. A total of 274 participants completed all of the course sections from the average of 350 eligible participants. Of 274 participants, more than half were female (64.96%), with more than half participants being General Practitioner (54.38%) followed by a neurologist (35.04%). For all sessions, a Wilcoxon signed-rank test outlined that differences between all pre-and post-test scores were significant (P < .001). There was a marked improvement in the post-test as evidenced by statistically significant increases in mean scores differences. We developed an educational training courses for physicians to address the limitation in existing medical undergraduate training of neuropathic pain management. The training led to improvement in participant's knowledge and skills with positive outcomes.Abbreviations: IASP = International association for the study of pain, SD = standard deviation.

Past literatures have reported that changes in serum vitamin D levels are related to cognitive dysfunctions, such as dementia, including Alzheimer’s disease (AD). However, these past studies vary in results on whether vitamin D levels correlated with the development of AD. This meta-analysis aimed to assess the associations between low vitamin D serum levels as risk factor of AD based on the latest evidence. We systematically searched Pubmed and additional references for relevant articles according to PRISMA guidelines from the beginning up to December 2022. The risk estimate of AD was determined using a pooled hazard ratio (HR) with 95% confidence intervals (CIs). five prospective trials and one cross-sectional study were analyzed. The meta-analysis showed that patients with low vitamin D serum levels (< 25 ng/ml) had an increased risk of developing AD compared to patients with normal vitamin D levels (≥ 25 ng/ml) (HR: 1.59, 95% CI: 1.09, 2.33, I2=77%). Further research is required to provide evidence on whether maintaining sufficient vitamin D serum levels may lower the risk of AD.